米力农联合无创呼吸机对老年肺心病伴急性心力衰竭患者血气、心肌受损和近期不良事件的影响

Effects of milrinone combined with non-invasive ventilator on blood gas,myocardial damage and short-term adverse events in elderly patients with pulmonary heart disease and acute

目的 探究米力农联合无创呼吸机对老年肺心病(PHD)伴急性心力衰竭(AHF)患者血气、心肌受损和近期不良事件的影响。方法 选择2021年7月~2023年7月当涂县人民医院急诊科收治的60例老年PHD伴AHF患者,按照随机数表法分为呼吸机组和联合组,各30例。呼吸机组在常规治疗基础上予以无创呼吸机治疗,联合组在呼吸机组基础上给予米力农治疗,治疗时间为7 d,比较两组治疗前后血气、心肌受损、心功能、肺动脉压指标水平及近期不良事件。结果 治疗后,联合组血氧分压(PaO_(2))、氧合指数(P/F)、氧饱和度(SaO_(2))高于呼吸机组,血二氧化碳分压(PaCO_(2))低于呼吸机组,差异有统计学意义(t=3.840、12.871、4.200、8.735,P<0.05)。治疗后,联合组肌红蛋白(Mb)、肌钙蛋白Ⅰ(cTnⅠ)、肌酸激酶同工酶(CK-MB)低于呼吸机组,差异有统计学意义(t=6.330、6.043、13.997,P<0.05)。治疗后,联合组右室Tei指数低于呼吸机组,右室射血分数(RVEF)、三尖瓣环收缩期位移(TAPSE)高于呼吸机组,差异有统计学意义(t=2.274、2.931、3.532,P<0.05)。治疗后,联合组肺动脉收缩压(PASP)、肺动脉平均压(MPAP)低于呼吸机组,差异有统计学意义(t=2.970、5.273,P<0.05)。两组近期总不良反应率和不良事件率差异无统计学意义(Fisher=0.472、0.424)。结论 米力农联合无创呼吸机治疗老年PHD伴AHF患者可以有效改善血气指标和心肌受损情况,并降低肺动脉压,值得临床应用。

Objective To investigate the effects of milrinone combined with non-invasive ventilator on blood gas,myocardial damage and short-term adverse events in elderly patients with pulmonary heart disease(PHD)and acute heart failure(AHF).Methods Sixty elderly patients with PHD and AHF who were admitted to the Emergency Department of Dangtu People's Hospital from July 2021 to July 2023 were selected and divided into a ventilator group and a combination group using the random number table,with 30 patients in each group,patients in the ventilator group were treated with non-invasive ventilator based on conventional treatment,and patients in the combination group were treated with milrinone on the basis of the treatment of ventilator group.Both groups of patients were treated for 7 d.Blood gas indicators,myocardial damage indicators,cardiac function indicators,pulmonary artery pressure indicators,and short-term adverse events were compared between the two groups.Results After treatment,partial pressure of oxygen(PaO_(2)),oxygenation index(P∕F),and oxygen saturation(SaO_(2))in the combination group were higher than those in the ventilator group.Partial pressure of carbon dioxide(PaCO_(2))was lower than that in the ventilator group(t=3.840,12.871,4.200,8.735,P<0.05).After treatment,the levels of myoglobin(Mb),cardiac troponinⅠ(cTnⅠ),and creatine kinase isoenzyme(CK-MB)in the combination group were lower than those in the ventilator group(t=6.330,6.043 and 13.997,P<0.05).After treatment,the right ventricular Tei index in the combination group was lower than those in the ventilator group,right ventricular ejection fraction(RVEF)and tricuspid annular plane systolic excursion(TAPSE)were higher than those in the ventilator group(t=2.274,2.931,3.532,P<0.05).After treatment,pulmonary systolic blood pressure(PASP),mean pulmonary artery pressure(MPAP)in the combination group were less than that in the ventilator group(t=2.970 and 5.273,P<0.05).There was no statistically significant difference in the rate of adverse reactions and the incidence of short-term adverse events between the two groups(Fisher=0.424).Conclusion The combined treatment with milrinone and non-invasive ventilator can effectively improve blood gas indicators and myocardial damage in elderly patients with PHD and AHF,and reduce their pulmonary artery pressure.